RN - Crushing medications

CapeCodMermaid, RN · Jun 22, 2016

Most places I've worked have policies that read: flush with 30 ml before the med pass, 5ml flush between each med, and 30ml after the pass. Someone needs to do an EVIDENCED based test on this to see if it's really necessary. It's old nursing I think and needs to be changed.

I've worked in a few places recently that still require the nurses to take a temp before a flu vaccine and every shift for 72 hours after. When I ask them why I get the "we've always done it that way" speech. Yeah....back in the day with it was a live vaccine. Let's get ourselves into this century.

Sorry....too much coffee and not enough sleep.

ShelbyaStar · Jun 22, 2016

I was also wondering about the fluid restrictions aspect. I am about to start my first LTC job but worked previously at a group home where I did flushes between meds, but this was for someone that was not on restrictions- thank goodness, because as it was his tube plugged allll the time.

This might be a dumb question- do you count liquid meds toward liquid intake for I&Os? Seems that could be reached awfully quickly, especially when you add in large flushes between every med.

kalycat, BSN, RN · Feb 14, 2017

I was also wondering about the fluid restrictions aspect. I am about to start my first LTC job but worked previously at a group home where I did flushes between meds, but this was for someone that was not on restrictions- thank goodness, because as it was his tube plugged allll the time.
This might be a dumb question- do you count liquid meds toward liquid intake for I&Os? Seems that could be reached awfully quickly, especially when you add in large flushes between every med.

Just to comment on some of the previous posts regarding proper flush volume, etc: What was recommended is also a copious amount of fluid for a pediatric patient with a tube - many of our kiddos w/congenital heart defects or CP receive meds per tube... and I try to protect patency as much as humanly possible. If I flushed with this much fluid, I would be in deep trouble. Same for my adult heart failure patients; we just do not have the luxury of using that much water.

With regard to your question on counting liquid meds in to fluid restrictions: we do not. The reasoning given is that a lot of the liquid meds we use are more of a suspension formulation that doesn't affect volume status very much. (That is our heart failure team's approach, anyway).

We have even switched to liquid meds, in some cases, for patients who could swallow but refused to do so without tons of water; it was a better trade off for the patient's fluid status and allowed them to save their liquids for meals. That said, I know that I have had patients who were on such tight restrictions that we counted a percentage of the liquid medication's volume. We typically count anything that is a liquid at room temperature... including those sherbet cups that patients love so much!

Elladora · Feb 19, 2017

7. For medications via tube: mix each crushed med with a minimum of 15 cc of water, 30 cc is better. Only one medication at a time. . .no mixing meds EVER)
a. stop the feeding;
b. flush with a MINIMUM of 60 cc of water (to clear the formula out of the tube)
c. administer ONE medication at a time
d. flush with a minimum of 30 CC water BETWEEN each dose of medication
e. at the end of the mad pass, flush tube again with 60 cc water BEFORE restarting the feeding.

I have multiple residents that are on tube feedings and NO meds are given like this. Per their doctor AND their pharmacist, the meds are mixed with 15 ml of water (30 ml if it's a large med pass) and flushed with a MAXIMUM of 30 ml of water. There is no "in between" because the meds are all given together. I have no one that gets anything separately at this time. 30 ml flush before, 30 ml flush after. Most simply would not tolerate the volume of flushing you are talking about.

Here.I.Stand, BSN, RN · Feb 24, 2017

It is essential that medication be given correctly....................
7. For medications via tube: mix each crushed med with a minimum of 15 cc of water, 30 cc is better. Only one medication at a time. . .no mixing meds EVER)
a. stop the feeding;
b. flush with a MINIMUM of 60 cc of water (to clear the formula out of the tube)
c. administer ONE medication at a time
d. flush with a minimum of 30 CC water BETWEEN each dose of medication
e. at the end of the mad pass, flush tube again with 60 cc water BEFORE restarting the feeding

I see this is an older thread, but good night.... the math for 10 meds works out to 570 ml for one med pass! And I did it with the "minimum" 15 ml vs the "better" 30 ml.

If it's a BID med pass, that pt has gotten 1140 ml of H2O with meds alone. So for a CHF'er with a 1000 ml, 1200 ml per day fluid restriction, do you simply deny them drinks? (And yes, some people do have a PEG for supplemental nutrition and take po foods/fluids.)

Also for those who take all po, but have elixirs due to difficulty swallowing pills, what happens to those individual meds? They mix and hit the small intestine together.

I've worked in 2 ICUs, one floor, one LTACH, and one SNF. We have never given meds singly like that. In the ICU we sometimes have q 2 hr med passes of 5-10 meds at a time. My a.m. med pass at the SNF took 3 hrs, and most of those were po meds. I'm trying to figure out THAT math in my head...like how in hades would you ever get anything else done?